Human Rights Education Impacts Medical Student Views of Torture

Integrating human rights education into the medical school curriculum may strengthen medical ethics with regards to physician participation in and acceptance of torture, according to the results of a new study from students and faculty from the Weill Cornell Center for Human Rights. The center is a Weill Cornell Medicine student-run organization that provides clinical assessments for people seeking political asylum in the United States.

Despite clearly stated ethical guidelines, some medical professionals continue to participate in or condone torture. To assess how Weill Cornell Medicine’s medical and MD-PhD students view such practices, the student and faculty leadership of the Weill Cornell Center for Human Rights (WCCHR) developed a 28-item survey that was circulated among the student body in November 2016. It queried students’ opinions related to specific torture activities, justifications for torture and ways physicians might participate in torture (for example, qualifying their agreement or disagreement with statements such as “The use of torture is an effective means of obtaining important information”).

The results, published Nov. 21 in the Health and Human Rights Journal, showed that the majority of respondents were opposed to torture, disagreed that torture is an effective way to obtain information, and supported professional and legal consequences for physicians who participate in torture. The survey also revealed that voluntary engagement in Weill Cornell’s human rights program was associated with significantly stronger opposition to torture.

“This study demonstrates how much impact participation in a voluntary, human rights program can have on participants’ attitudes toward a sensitive and important topic that’s not usually covered in a standard curriculum,” said senior author Dr. Thomas Kalman, a clinical professor of psychiatry at Weill Cornell Medicine and WCCHR co-medical director.

The Weill Cornell Medicine survey was inspired by a 2008 University of Illinois College of Medicine-Chicago (UIC) study of medical student attitudes toward torture – the only previous survey on this topic at an American medical school. In the current study, the questionnaire was sent to 483 Weill Cornell Medical College and Tri-Institutional MD-PhD students, with 121 recipients responding with completed surveys.

“We looked at this study from UIC and thought it would be important to not only replicate it but also expand on it,” said first author Krista Dubin, an MD-PhD student at Weill Cornell Medicine and WCCHR senior student advisor. “We wanted to see what people thought about torture, and how their demographics and experiences, such as if they have been harassed in the past, affect their view on it.”

In comparison to UIC survey respondents, a larger proportion of Weill Cornell Medicine students opposed torture. For example, when asked if it was permissible for interrogators to use psychological intimidation, 93 percent of Weill Cornell Medicine respondents disagreed, compared with only 30 percent of UIC respondents.

“That was an interesting finding, but it’s possible the phrasing of the questions had an impact on the results,” said study author Andrew Milewski, an MD-PhD student at Weill Cornell Medicine and WCCHR co-executive director. “We included examples of what psychological intimidation could look like, while the UIC study didn’t. Geographic and demographic differences also make it difficult to draw comparisons between our two institutions nearly a decade later.”

Respondents who had experienced discrimination or harassment answered the survey in ways that reflected stronger pro-torture attitudes, but the trend did not reach statistical significance.

It’s also possible that current events may have shaped the students’ responses. Study authors sent out the survey shortly after the conclusion of last year’s national election. “This added an interesting component, considering all of the talk around torture that happened during the election cycle,” Milewski said.

When it comes to human rights education, the authors found that students trained by the WCCHR were significantly more opposed to torture than those who had not participated. They also were less likely to agree that obtaining life-saving information justifies the use of torture or that it’s permissible for physicians to treat individuals so that torture can begin or continue.

Founded upon the tenets of service and education, the WCCHR aims to expose students to the idea of human rights abuses and the role physicians can play in documenting signs of torture. Students learn about the different forms of torture and provide service by participating in pro bono evaluations of asylum seekers. As part of their research, the study authors surveyed the incoming class of 2017 to learn how many of them had heard of the WHCCR. They found that more than one-third of them had, and that the center was one of the reasons why they chose to attend Weill Cornell Medicine, Milewski said.

“We are the first student-run asylum clinic in the nation,” Milewski said. “Our hope is that the results of our survey will inspire students at other institutions to create similar organizations.”

While medical schools often handle issues of professionalism and ethics in a standard curriculum, the specific issues around torture or other human rights issues “are addressed in a more variable fashion,” said study author Dr. Joseph Shin, an assistant professor of medicine and WCCHR co-medical director. He hopes these results lead to the implementation of human rights education into the medical school curricula, both at Weill Cornell and beyond.